Emergency Management & Mental Health and Wellness

“Carrie, what mental health and wellness practices should we be incorporating into our emergency management programs?”

Great question. Glad you asked.

Emergency management organizations operate in two modes: 1) Daily, routine business, and 2) Activations, which include response and long-term recovery. While mental health and wellness (MH&W) programs need to span the entirety of those operations, the nuances of how they are implemented may vary depending on the mode. Let’s explore those differences.

Daily, routine business, isn’t always fast-paced and emergent. But managing a comprehensive emergency management program often means balancing large, complex, and dynamic workloads, even in the absence of an emergency. Often, a day will begin as routine and then quickly transition if (more like when) an emergency occurs—which means, a “normal” workday isn’t really all that normal in emergency management. For staff, the ever-changing and over-flowing workload can lead to burn out, exhaustion, and feeling overworked.

In contrast, activation activities are fast-paced and typically focused on life and property-saving actions. The work environment is lively, and it’s typical for emergency managers to feel like they’re working against the clock. A common misperception is that we spend all our time in the emergency operations center, but in reality, emergency managers may directly interact with survivors through managing family assistance centers, mass care shelters, and points of distribution, etc. By providing these services, they may be exposed to the emergency or traumatic event, like a building fire, infrastructure collapse, severe weather, or acts of gun violence. Transitioning from response to long-term recovery also includes engaging with survivors, stakeholders and partners, and the public—which may last months or years depending on the disaster.

Both routine business and activations impact employee wellness, and it’s important to shift the provision of offerings for each mode.

Cost Considerations

Not all elements of a MH&W program cost money. While some advocates will say that the price of MH&W shouldn’t dissuade leaders from implementing a program—the reality is such that in emergency management, limited resources result in difficult decisions. Resources are often prioritized towards building organization or jurisdiction capabilities instead of the workforce, simply because we need to execute a mission.

There is hope on the horizon, however. In response to the FEMA National Advisory Council’s 2023 annual report, FEMA agreed to review the Public Assistance Program and Policy Guide (PAPPG) and consider expanding program eligibility to include the provision of mental and behavioral health services for responders. While these program and policy changes are underway, emergency managers should start identifying ways to provide MH&W support to their staff.

Program Elements Tailored for Emergency Management

Given emergency management’s complex operating environment and limited resources, I’ve created a list of MH&W program elements that consider these differences. Some are no and low-cost options that may be incorporated into a program with only slight shifts in managerial or leadership approaches. Others may require additional resources, like creating operating units within the incident management structure or by engaging third-party mental health providers.  

Low and No-Cost MH&W Elements Focused on the Work Environment

Wellness rooms offer an opportunity for staff to recalibrate, rejuvenate, and re-energize, away from their workstation or office. The lighting and furniture of the rooms should be designed for quiet comfort, with limited distractions. While natural lighting is preferred, room options for emergency management organizations may be limited, and if that is the case, a thoughtfully designed enclosed space dedicated to wellness is better than not having one at all.

Exposure to natural light has a powerful effect on mental and physical well-being. Since not all offices were designed with natural light in-mind, staff should be encouraged to take frequent breaks outside or in other building spaces with optimal lighting. During a standard 12-hour activation shift, exposure to natural light 3-4 times is ideal.

Healthy food options should be available during activation mealtimes, though admittedly, these options may be severely limited after an emergency. Where possible, include fresh or dried fruit and vegetables, cereals, and lean protein options. Caffeinated beverages may be provided (this is often a non-negotiable during activations), but sugar-filled drinks should be limited. If your organization has a stock room or full kitchen, it may be best to bulk-purchase dried health foods to ensure adequate supplies on-hand when needed.

Setting boundaries, and honoring them, are critical components of a MH&W program. Managers at all levels should lead by example by limiting extended shift schedules, taking rest periods or breaks and encouraging others to do the same, and ensuring staff rotations and demobilizations occur as scheduled. Beyond activations, leaders can set an example by going on extended leave/vacations, avoiding sending emails outside work hours, and promoting an environment that values life/work balance (see what I did there?).

Wellness check-ins are intentional interactions between management and staff. In these conversations, priority and focus should be on the wellness of the staff member. These check-ins should occur with regular frequency and offer genuine support and acknowledgement of staff time and effort.  

Incident Management MH&W Elements

Wellness Units, as part of an incident command structure or center support model, should be a standard unit activated for incidents spanning multiple operational periods. The Wellness Unit should be led by a Wellness Officer as a member of the command staff, or the Safety Officer if bandwidth allows. Or, if preferred, the unit could report into the Logistics Section as incident support, or center support.

The Wellness Unit should coordinate critical incident stress debriefings for all staff, ensure rotations and breaks occur as scheduled, and maintain the wellness rooms and break rooms. Most importantly, this unit should monitor the stress level of responding staff and discretely intervene when needed to promote and protect staff mental health and wellness.

Buddy systems can be established voluntarily or more formally depending upon the culture of the organization. In either case, the system is created to ensure each staff member has a dedicated person identified to monitor their stress and wellbeing during an activation. These systems can be put into place in the emergency operations center, in the field, or in the office. Strong, interpersonal relationships are the foundation of this element, so in more formal work environments, this element may not be the best fit.

Therapy animals, or emotional-support animals such as dogs, may be brought into the emergency operations center to make a positive impact on mental and physical health. Therapy animals may help with coping and recovery from an incident, and their presence may help to decrease stress levels. In many jurisdictions, law enforcement or fire departments have therapy animals that can visit the emergency operations center. If that isn’t an option, other programs like FirstNet’s ROG the DOG may be requested depending on the circumstances. Note: All staff should be notified before the arrival of an animal due to the potential for allergen sensitivities or animal-induced anxiety.

Third-Party Provider Elements

Intergovernmental agreements (IGA’s) between an emergency management organization and a mental and behavioral health organization should be established for long-term counseling care.

If a jurisdiction has a department of mental and behavioral health, it may be possible for an IGA to be established whereby crisis counselors can be assigned to an emergency management organization at a discounted rate. These IGAs can be time-limited and bound by an emergency declaration, or on-going and re-established annually between the two organizations. In the first case, services would be tied directly to an ongoing activation and suspended when the declaration ends. And in the latter case, annual agreements can be established to provide on-going counseling services for staff, regardless of an activation.

In either case, program guidelines need to ensure fair and distributed care for all staff. Additionally, this approach should allow for counseling services to be provided on site or at another location to promote discretion and privacy. And last, services should be provided at the request of a staff member, as well as proactively by a counselor (i.e., without staff making contact first). Why? Simply put: Individuals who have experienced work-related trauma may not have the motivation, or be in the right headspace, to voluntarily reach out to a counselor. Therefore, programs should always include proactive outreach to effected staff for periodic check-ins.  

Note: Crisis counseling services provided to emergency managers (during an activation or other setting) are not currently a grant eligible expense—however, with a pending update to the PAPPG, it is possible that this type of activity could be reimbursable in the future. Emergency managers should advocate for the eligibility of crisis counseling support within their MH&W programs, as it is the most comprehensive and flexible, clinical approach, to incorporate into routine business and activations.

Mobile applications like Calm, Headspace, Sanvello, Happify, Bearable, and others, are subscription-based applications that focus on cognitive behavioral therapy, talk therapy, exposure therapy, meditation, mindfulness, and stress management. And in all cases, the apps can be used whenever it is most convenient for the user.

While each app can be individually purchased for a monthly or annual fee, organizations could consider group subscriptions which may be offered at a discounted rate. In doing so, emergency management organizations could include these applications as part of the standard app set-up on the mobile devices they provide to each staff member— increasing access to mental health and wellness resources across the board.